What is psoriasis?

Psoriasis is a chronic autoimmune condition that causes the rapid build-up of skin cells. This build-up of cells causes scaling on the skin’s surface. Inflammation and redness around the scales is fairly common. Typical psoriatic scales are whitish-silver and develop in thick, red patches. Sometimes, these patches will crack and bleed.

Psoriasis is the result of a sped-up skin production process. Typically, skin cells grow deep in the skin and slowly rise to the surface. Eventually, they fall off. The typical life cycle of a skin cell is one month.

In people with psoriasis, this production process may occur in just a few days. Because of this, skin cells don’t have time to fall off. This rapid, overproduction leads to the build-up of skin cells.

Scales typically develop on joints, such elbows and knees. They may develop anywhere on the body, including the hands, feet, neck, scalp, and face. Less common types of psoriasis affect the nails, the mouth, and the area around genitals.

Plaque psoriasis: This is the most common type of psoriasis — about 80 percent of people with the condition have plaque psoriasis. It causes red, inflamed patches that cover areas of the skin. These patches are often covered with whitish-silver scales or plaques. These plaques are commonly found on the elbows, knees, and scalp.

Guttate psoriasis: Guttate psoriasis is common in childhood. This type of psoriasis causes small pink spots. The most common sites for guttate psoriasis include the torso, arms, and legs. These spots are rarely thick or raised like plaque psoriasis.

Pustular psoriasis: Pustular psoriasis is more common in adults. It causes white, pus-filled blisters and broad areas of red, inflamed skin. Pustular psoriasis is typically localized to smaller areas of the body, such as the hands or feet, but it can be widespread.

Inverse psoriasis: Inverse psoriasis causes bright areas of red, shiny, inflamed skin. Patches of inverse psoriasis develop under armpits or breasts, in the groin, or around skinfolds in the genitals.

Erythrodermic psoriasis: This type of psoriasis often covers large sections of the body at once and is very rare. The skin almost appears sunburned. Scales that develop often slough off in large sections or sheets. It’s not uncommon for a person with this type of psoriasis to run a fever or become very ill.

Psoriasis symptoms differ from person to person and depend on the type of psoriasis. Areas of psoriasis can be as small as a few flakes on the scalp or elbow, or cover the majority of the body.

The most common symptoms of plaque psoriasis include:

red, raised, inflamed patches of skin

silver-white scales or plaques on the red patches

dry skin that may crack and bleed

soreness around patches

itching and burning sensations around patches

thick, pitted nails

painful, swollen joints

Not every person will experience all of these symptoms. Some people will experience entirely different symptoms if they have a less common type of psoriasis.

Most people with psoriasis go through “cycles” of symptoms. The condition may cause severe symptoms for a few days or weeks, and then the symptoms may clear up and be almost unnoticeable. Then, in a few weeks or if made worse by a common psoriasis trigger, the condition may flare up again. Sometimes, symptoms of psoriasis disappear completely.

When you have no active signs of the condition, you may be in “remission.” That doesn’t mean psoriasis won’t come back, but for now you are symptom free.

Scientists are unclear as to what causes psoriasis. However, thanks to decades of research, they have a general idea of two key factors: genetics and the immune system.

Immune system

Psoriasis is an autoimmune condition. Autoimmune conditions are the result of the body attacking itself. In the case of psoriasis, white blood cells known as T cells attack the skin cells mistakenly.

In a typical body, white blood cells are deployed to attack and destroy invading bacteria and fight infections. The mistaken attack causes the skin cell production process to go into overdrive. The sped-up skin cell production causes new skin cells to develop too quickly. They are pushed to the skin’s surface, where they pile up.

This results in the plaques that are most commonly associated with psoriasis. The attacks on the skin cells also cause red, inflamed areas of skin to develop.

Genetics

Some people inherit genes that make them more likely to develop psoriasis. If you have an immediate family member with the skin condition, your risk for developing psoriasis is higher. However, the percentage of people who have psoriasis and a genetic predisposition is small. Approximately 2 to 3 percent of people with the gene develop the condition.

Physical examination

Most doctors are able to make a diagnosis with a simple examination. Symptoms of psoriasis are typically evident and easy to distinguish from other conditions that may cause similar symptoms.

During this exam, be sure to show your doctor all areas of concern. In addition, let your doctor know if any family members have been diagnosed with psoriasis.

Biopsy

If the symptoms are unclear or if your doctor wants to confirm their suspected diagnosis, they may take a small sample of skin. This is known as a biopsy.

The skin will be sent to a lab, where it will be examined under a microscope. The examination can diagnose the type of psoriasis you have. It can also rule out other possible disorders or infections.

Most biopsies are done in your doctor’s office the day of your appointment. Your doctor will likely inject a local numbing medicine to make the biopsy less painful. When the results return, your doctor may request an appointment to discuss the findings and treatment options with you.

External “triggers” may start a new bout of psoriasis. These triggers aren’t the same for everyone. They may also change over time for you.

The most common triggers for psoriasis include:

Stress: Unusually high stress may trigger a flare. If you learn to reduce and manage your stress, you can reduce and possibly prevent flares.

Alcohol: Heavy drinking or alcohol consumption can trigger psoriasis flares. If you binge drink or drink heavily, psoriasis outbreaks may be more frequent. If you have a problem with alcohol, talk with your doctor about getting help to quit drinking. Reducing alcohol consumption is smart for more than just your skin.

Injury: If you have an accident, cut yourself, or scrape your skin, you may trigger a psoriasis outbreak. Shots, vaccines, and sunburns can also trigger a new bout with the skin condition.

Medications: Some medications are considered psoriasis triggers. These medications include lithium, antimalarial medicines, and high blood pressure medication.

Infection: Psoriasis is caused, at least in part, by the immune system mistakenly attacking healthy skin cells. If you’re sick or battling an infection, your immune system will go into overdrive to fight the infection. This might start another psoriasis bout. Strep throat is a common trigger.

Psoriasis has no cure. Treatments aim to reduce inflammation and scales, slow the growth of skin cells, and remove plaques. Psoriasis treatments fall into three categories: topical treatments, systemic medications, and light therapy.

Topical treatments

Creams and ointments applied directly to the skin can be helpful for reducing mild to moderate psoriasis.

Topical psoriasis treatments include:

topical corticosteroids

topical retinoids

anthralin

vitamin D analogues

salicylic acid

moisturizer

Systemic medications

People with moderate to severe psoriasis, and those who have not responded well to other treatment types, may need to use oral or injected medications. Many of these medicines have severe side effects, so doctors usually prescribe them for short periods of time.

Light therapy

This psoriasis treatment uses ultraviolet (UV) or natural light. Sunlight kills the overactive white blood cells that are attacking healthy skin cells and causing the rapid cell growth. Both UVA and UVB light may be helpful in reducing symptoms of mild to moderate psoriasis.

Most people with moderate to severe psoriasis will benefit from a combination of treatments. This type of therapy uses more than one of the treatment types to reduce symptoms. Some people may use the same treatment their entire lives. Others may need to change treatments occasionally if their skin stops responding to what they’re using.

If you have moderate to severe psoriasis, or if psoriasis stops responding to other treatments, your doctor may consider an oral or injected medication.

The most common oral and injected medicines used to treat psoriasis include:

Biologics: This class of medications alters your immune system and prevents interactions between your immune system and inflammatory pathways. These medications are injected or given through intravenous (IV) infusion.

Retinoids: These medicines reduce skin cell production. Once you stop using them, symptoms of psoriasis will likely return. Side effects include hair loss and lip inflammation. Women who are pregnant or may become pregnant within the next three years shouldn’t take retinoids because of the risk of possible birth defects.

Cyclosporine:This medicine prevents the immune system’s response, which can ease symptoms of psoriasis. It also means you have a weakened immune system, so you may become sick more easily. Side effects include kidney problems and high blood pressure.

Methotrexate: Like cyclosporine, this medicine suppresses the immune system. It may cause fewer side effects when used in low doses, but over the long-term it can cause serious side effects. These include liver damage and reduced production of red and white blood cells.

Food cannot cure or even treat psoriasis, but eating better might reduce symptoms. These five lifestyle changes may help ease symptoms of psoriasis and reduce flares:

Lose weight: Losing weight may reduce the disease’s severity. Losing weight may also make treatments more effective. It’s unclear how weight interacts with psoriasis, so even if your symptoms remain unchanged, losing weight is still good for your overall health.

Eat heart healthy: Reduce your intake of saturated fats, which are found in animal products like meats and dairy foods. Increase your intake of lean proteins that contain omega-3 fatty acids, such as salmon, sardines, and shrimp. Plant sources of omega-3s include walnuts, flaxseeds, and soybeans.

Drink less alcohol: Alcohol consumption can increase your risks of a flare. Cut back or quit entirely. Talk with your doctor if you have a problem with alcohol.

Consider taking vitamins: Some doctors prefer a vitamin-rich diet to vitamins. However, even the healthiest eater may need help getting adequate nutrients. Ask your doctor if you should be taking any as a supplement to your diet.

Life with psoriasis can be challenging, but with the right approach you can reduce flares and live a healthy, fulfilling life. These three areas will help you cope in the short-term and long-term:

Diet

Losing weight and maintaining a healthy diet can go a long way toward helping ease and reduce symptoms of psoriasis. This includes eating a diet rich in omega-3 fatty acids, whole grains, and plants. You should also limit foods that may increase your inflammation, such as refined sugars, dairy products, and processed foods.

Stress

Stress is a well-established trigger for psoriasis. Learning to manage and cope with stress may help you reduce flares and ease symptoms. Meditation, journaling, breathing, and yoga are just a few of the ways you may find success at reducing stress.

Emotional health

People with psoriasis are more likely to experience depression and self-esteem issues. You may feel less confident when new spots appear. Talking with family members about how psoriasis affects you may be difficult, and the constant cycle of the condition may be frustrating.

All of these emotional issues are valid, and it’s important you find a resource for handling them. This may include speaking with a professional mental health expert or joining a group for people with psoriasis.

About 15 percent of people with psoriasis will develop psoriatic arthritis. This type of arthritis causes swelling, pain, and inflammation in affected joints. It’s commonly mistaken for rheumatoid arthritis and gout. The presence of inflamed, red areas of skin with plaques usually distinguishes this type of arthritis from others.

Psoriatic arthritis is a chronic condition. Like psoriasis, the symptoms of psoriatic arthritis may come and go, alternating between flares and remission. Psoriatic arthritis can also be continuous, with constant symptoms and issues.

This condition typically affects large joints of the lower body, including your knees and ankles. It can also affect your fingers, toes, back, and pelvis.

Most people who develops psoriatic arthritis have psoriasis. However, it’s possible to develop the joint condition without having been diagnosed with psoriasis. Most people who are diagnosed with arthritis without the skin condition have a family member with psoriasis.

Treatments for psoriatic arthritis may successfully ease symptoms, relieve pain, and improve joint mobility. As with psoriasis, losing weight, maintaining a healthy diet, and avoiding triggers may also help reduce psoriatic arthritis flares. An early diagnosis and treatment plan can reduce the likelihood of severe complications, including joint damage.

Psoriasis may begin at any age, but most diagnoses occur in adulthood. The average age of onset is 33 years old. About 75 percent of psoriasis cases are diagnosed before age 46. A second peak period of diagnosis occurs in the late 50s and early 60s.

Having a family member with the condition increases your risk for developing psoriasis. However, many people with the condition have no family history at all, and some people with a family history won’t develop psoriasis.

About 15 percent of people with psoriasis will be diagnosed with psoriatic arthritis. In addition, people with psoriasis are more likely to develop conditions such as type 2 diabetes, kidney disease, cardiovascular disease, and high blood pressure.

Though the data isn’t complete, research suggests cases of psoriasis are becoming more common. Whether that’s because people are developing the skin condition or doctors are just getting better at diagnosing it is unclear.